VICTOR VARGAS
Dependent on policy B04M000180
Claims
2
Attributed to this person
Charged
1,047.00
Total submitted
Denied
428.96
2 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | VICTOR VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000180 |
| Date of birth | 18 Jun 2006 |
| Plan | PLATINUM PPO |
| Covered from | 22 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000816 | 21 May 2025 | 269.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 269.00 |
| CLM0000815 | 29 Dec 2024 | 778.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 159.96 |